Perceptions of geriatric medicine junior faculty on success in academic medicine: the Saint Louis University Geriatric Academy (SLUGA) Faculty Development Program.

THE quadruple-threat ‘‘gold standard’’ of a successful academician: researcher, educator, clinician, and leader, is becoming increasingly difficult to achieve in the current academic environment. Success, for promotional purposes, has traditionally focused on research activity and grant funding. With fewer physicians engaging in research and the competition for grant dollars increasing, faculty, and to a lesser extent, institutions, are focusing on other means of demonstrating achievement and productivity. One such strategy is to allow promotion based on nonresearch-dominant ‘‘tracks.’’ Tenure as a ‘‘ClinicianEducator’’ is a relatively new phenomenon, and the most common of these alternative pathways. The American Geriatrics Society has even published guidelines for the promotion of Clinician Educators in Geriatric Medicine (1). These guidelines suggest that promotion should be based on the impact of teaching activities, educational contribution, and scholarly activity related to teaching. Alternative tenure pathways are not uniformly accepted, and the promotional criteria are often nebulous. In 1997, nearly 75% of medical/osteopathic schools had promotional pathways for nonresearch faculty; however, only 20% of these tracks offered tenure status (2). The impact and importance of tenure is of growing concern to academic clinicians. Salary guarantees, appointment continuance, and protected time, even with tenure, are far less secure (2,3). Applying credit for nonclinical/research duties, as a measure of productivity, is of increasing importance for faculty on a tenure track. Academic ‘‘worth’’ has traditionally been measured in research and clinical revenue. This has caused much consternation for faculty with responsibilities that are neither 100% patient care nor 100% research. Of late, models for measuring productivity and performance-based compensation plans have been implemented in some academic medical centers. At Vanderbilt University School of Medicine, faculty are appointed to one of five tracks based on research, educational, and clinical responsibilities (4). Relative Value Units (RVUs) are assigned for clinical care revenue, grant revenue, nonclinical revenues (i.e., medical directorships), and major educational activities (i.e., course directorships). Base salary and bonus calculations are based on the generated and expected RVUs. Like other academic organizations, the Veteran’s Affairs Medical Center (VAMC) system is facing similar academic challenges. Changes in VAMC service utilization and patient demographics have lead to a reallocation of research funding and a greater emphasis on career development programs. At one VAMC, a productivity model has been used to link current procedural terminology codes to RVUs (5). In this system, physician productivity is measured in clinical Full Time Equivalents, research, educational activities, and administrative responsibilities. Resources are allocated based on a research, teaching, and patient care model. These methods attempt to credit academicians for all forms of work and provide means for measuring success. To address the new academic challenges, faculty development programs (FDPs) have evolved to prepare young physicians for an academic career (6). In a prospective study, faculty participating in FDPs were compared with nonparticipating control faculty. Teaching ability was rated significantly higher by trainees for postcourse FDP faculty compared with control faculty (7). At one institution, 80% (n 5 30) of faculty who participated in career development program coursework felt that it had a positive impact on their academic potential (8). Well-known FDPs in the United States include Stanford’s ‘‘Train the Trainer’’ Program and the Harvard Medical School Macy Program for Physician Educators (9). Graduates of FDPs are likely to be highly productive